Recommendations and advice by the ERC is advisory and nonbinding. However, there are special requirements when surrogates make medical decisions under the FHCDA, based on "irreversible or incurable condition".

Hospitals: Withdrawing or withholding artificial nutrition and hydration in a hospital over the attending physician's objection

If the attending physician objects to the order, the ERC (including a physician who is not directly responsible for the patient's care) or an appropriate court must determine that the medical order meets the required standards.

Nursing Homes: For Life-Sustaining Treatment orders other than DNR orders

The ERC, (including at least one physician who is not directly responsible for the patient's care) or an appropriate court must determine that the medical orders meet the required standards.

Emancipated Minor Decisions:

The ERC review is required to withhold or withdraw LST without the consent of parent or guardian.

Bomba, P. A., Morrissey, MB., Leven, D.C. (2011). Key Role of Social Work in Effective Communication and Conflict Resolution Process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and Shared Medical Decision Making at the End of Life. Journal of Social Work in End-Of-Life & Palliative Care Vol. 7, Issue 1, 56 - 82.